| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AHEARN, JAMES FRANCIS3 | 740 REGENT ST. #400 MADISON, WI 53725 | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | $29K | — | $29K | 4.82% |
| HAUSMANN-JOHNSON INSURANCE INC3 | PO BOX 259408 MADISON, WI 53725 | UNITEDHEALTHCARE INSURANCE COMPANY | $10K | — | $10K | 3.75% |
| KEY BENEFIT CONCEPTS3 | 200 W SUMMIT AVE STE 270 WALES, WI 53183 | WYSSTA INSURANCE COMPANY INC | $688 | — | $688 | 8.78% |
| HAUSMANN-JOHNSON INSURANCE INC3 Filed as: HAUSMANN-JOHNSON INSURANCE | 740 REGENT ST. #400 MADISON, WI 53715 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $383 | $43 | $426 | 12.28% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $5K |
| HAUSMANN-JOHNSON INSURANCE INC INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | PO BOX 259408 MADISON, WI 53715 | $584 |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 119 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 1 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 6 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 126 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical)(2 contracts, 2 carriers) | GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN | 81 | $870K |
| Vision | WYSSTA INSURANCE COMPANY INC | 63 | $8K |
| Life insurance | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $3K |
| Long-term disability | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $3K |
| Other | UNUM LIFE INSURANCE COMPANY OF AMERICA | 115 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 115 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.